Medicaid Reimbursement Updatehoranmm.com/wp-content/uploads/2016/11/Capital...Traumatic Brain Injury...
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Medicaid Reimbursement Update
December 1, 2016
Presented by: Joseph F. Martello, CPA Managing Partner HMM, CPAs LLP
Intercounty Health Facilities Association
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Today’s Agenda… Reimbursement – Benchmark Rates Direct/Indirect Component Rate Add-Ons Capital Rate Streamlining Debt Refinancing / Shared Savings Initiative Energy Audits Rate Update Advanced Training Initiative Universal Settlement
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Benchmark Rates
• Direct – Adjusted on Case Mix (with a cap over/under 5%) • Indirect – Price • Non Comparable – 2007 RHCF-4 • Rate Add-On Dementia, TBI, BMI • Property – 2015 RHCF-4, 2017 Rates
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Direct / Indirect Component
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DIRECT COMPONENT
RATE TRANSITION > 300 BED YEAR YEAR < 300 BEDS > 300 BEDS DIFFERENCE 2015 Year 4 114.32 124.46 10.14 2016 Year 5 114.85 125.03 10.18 2017 Year 6 115.37 125.59 10.22
INDIRECT COMPONENT
RATE TRANSITION > 300 BED YEAR YEAR < 300 BEDS > 300 BEDS DIFFERENCE 2015 Year 4 56.66 63.93 7.27 2016 Year 5 56.92 64.23 7.31 2017 Year 6 57.18 64.52 7.34
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Rate Add-Ons
MDS * Dementia $ 8.00 Section I4200 CA, BA, PA, PB
Traumatic Brain Injury (TBI) $ 36.00 Section I5500
Bariatric (BMI) $ 17.00 Section K0200 * Changes twice a year (1/1 & 7/1) based on submission of MDS
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• Timeline o Early October – Initial 2017 Capital rate using automated
system and adjusted for known issues o December 2, 2016– Attestations for Corrections due o Initial 2017 rate, including capital with operator-certified
changes
• DOH involvement will be reduced with reliance upon a facility’s attestations; subject to OMIG audit
• Significant reduction in the number of capital appeals
Capital Rate Streamlining
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• Proposed Requirements o Closing date of refinancing must occur on or after 4/1/15
o Approved refinancing of previously approved financing
o Shared savings is 50% of interest savings only
o Only consider savings on o/s prior approved principal
NO closing costs
NO additional capital costs
o Written request to refinance is required as before
Debt Refinancing/Shared Savings Initiative
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• As part of the 2016-17 Executive Budget, DOH and NYSERDA (NYS Energy Research and Development Authority) working with energy audit firms to conduct energy audits.
• No cost to the facility receiving audit. • Facilities eligible are higher energy users. • Non Comparable – 2007 RHCF-4 • Call Tracey DeSimone at (518)-862-1090
x.3452 with questions.
Energy Audits
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Rate Update
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LATEST
TRANSITION DATE RATE DATE DATE PROCESSED
YEAR CMI EFFECTIVE DATE APPROVED 5%
OVER/UNDER Year 1 1/1/2012 7/1/2012 7/24/2013 7/29/2013
Year 2 7/1/2012 1/1/2013 3/7/2016 TBD
Year 2 1/1/2013 7/1/2013 1/15/2016 TBD
Year 3 7/1/2013 1/1/2014 1/15/2016 TBD
Year 3 1/1/2014 7/1/2014 8/3/2015 TBD
Year 4 7/1/2014 1/1/2015 8/3/2015 TBD
Year 4 1/1/2015 7/1/2015 2/2/2016 TBD
Year 5 7/1/2015 1/1/2016 9/7/2016 TBD Year 5 1/1/2016 7/1/2016 TBD TBD
Transition is Done 7/1/2016 1/1/2017 TBD TBD
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2016/2017 Advanced Training Initiative
• $46 Million has been appropriated • Teach staff to detect early changes in
resident’s physical, mental or functional status that could lead to an avoidable hospitalization
• DOH using 2015 RHCF-4, Schedule P – Staff Turnover
• Per Diem add-on to rate if facility is above the State mean (78.8%) 10
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• First and Second Installments paid in 2016. • Third Installment is due to be paid sometime
during the State Fiscal Year beginning 4/1/2017.
• The third installment could be paid sooner if room remains under the Medicaid Global Cap.
Universal Settlement
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Rate Sheet
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Rate Sheet
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Rate Sheet
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Rate Sheet
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Rate Sheet
* * = Goes on Rate Sheet
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Rate Sheet
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Rate Sheet
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Rate Sheet
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Information Not Presented on Slides
PPS Rates Tab 2 Page 1-2 Co-Insurance Bad Debts Tab 2 Page 6 Assessment Reconciliation Tab 2 Page 8-9 Nurses Aide Training Tab 2 Page 10 Flu Shots Tab 5 Page 12 Exclusions Under BBRA Tab 5 Page 1-11 Corporate Compliance Tab 7 Page 1-7 Record Retention Tab 8 Page 1-5
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Joseph F. Martello, CPA Managing Partner HMM, CPAs LLP Office: (631) 265-6289 E-Mail: [email protected] www.horanmm.com
THANK YOU - Questions?